Healthcare Provider Details

I. General information

NPI: 1710277918
Provider Name (Legal Business Name): NIRAV H. SHAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2011
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1779 KIRBY PKWY # 18009
MEMPHIS TN
38138-3666
US

IV. Provider business mailing address

PO BOX 13308
MESA AZ
85216-3308
US

V. Phone/Fax

Practice location:
  • Phone: 833-497-3786
  • Fax:
Mailing address:
  • Phone: 480-335-1865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA134729
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberE-11830
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number60672774
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number58571
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number27179
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: